Debelle et al. compiled a list of botanical selleck screening library agents known to contain AA.65 Despite a ban in many countries, products containing AA continue to be widely available. Inappropriate nomenclature and imprecise labelling are other confounding issues. Cheung et al.35 found AA in a number of Chinese raw herbs and manufactured herbal products, many of which were due to the complexity of nomenclature leading to mistaken identification. It is

also possible that more nephrotoxic plants still remain unidentified. The possibility of plants being responsible for CKD in other parts of the world has been suggested. A large proportion of CKD patients in the Indian subcontinent present with a relatively short history, advanced renal failure, little or no oedema, mild hypertension and small

smooth kidneys. The primary disease in most of these cases Gemcitabine in vivo remains a mystery.86 Out of over 3000 consecutive patients seen at our Institute, the aetiology could not be determined in over one-third. Clusters of CKD have also been reported from Sri Lanka, affected individuals being male farmers of poor socioeconomic status in the north-central provinces.87,88 Similar presentation has been described amongst South Asians living in the UK.89 The role of environmental toxins, such as herbs, pesticides or other chemicals in the genesis of CKD either directly or through contamination of drinking water, rice or edible fish65,87,88,90 has been proposed but remains unproven as yet. A recent Thai study91 showed an inverse relationship between the prevalence of CKD and the developmental status of the society. The prevalence increased progressively from urban areas to urban slums to the villages, suggesting the presence of unique risk factors in a less developed population. Lack of regulation is a major factor behind the widespread use of potentially toxic herbs. Classification as ‘dietary supplements’ keeps them out of the ambit of efficacy and safety requirements in the

DOK2 USA.17 The European Community introduced a list of unacceptable herbs and made adverse event reporting mandatory in 2004.57 However, locally prepared medicines using crude herbal ingredients and non-medicinal herbal products continue to be exempt from such rules. In conclusion, the use of herbal remedies is common in large parts of the developing world, especially amongst the rural population. The true incidence of CKD due to nephrotoxic herbs remains uncertain. The structural and functional abnormalities are non-specific and may be overlooked. AA, present in a number of commonly used plants has been proved to cause chronic interstitial nephritis and urothelial malignancy. Clinical inquiry should be extended to include the possibility of use of herbal medicine when investigating a case of unexplained kidney disease or urothelial carcinoma. Regulatory control is essential to prevent toxicity due to misuse of herbs.

15,16 Recently, it has been shown that the recovery of GFR within 1 month of delivery is largely attributable to recovery of filtration capacity. Moran et al. were able to show that all elements of GFR control, that is, blood flow, surface area and transfer coefficients, are altered in preeclampsia17 and that changes in basement membrane size-selectively

are relevant to the development of proteinuria. The estimation and subsequent quantification of proteinuria Ferrostatin-1 price remains a challenge in preeclampsia diagnosis. Much work has been done to validate a spot urine test of protein : creatinine ratio to establish a firm diagnosis of proteinuria18 compared with the clinical ‘gold standard’ of a 24 h urine collection for protein assessment. The threshold for abnormal protein excretion is increased to 300 mg per day, or 30 mg/mmol creatinine.19 This threshold is an all or none categorization of renal involvement as there has been no evidence that the foetal or maternal outcomes are directly related to the degree of proteinuria. In everyday clinical practice the spot test has the ease of collection but requires local validation; in some centres the protein creatinine ratio is still questioned in terms of reliability.20 In contrast to spot urinary protein : creatinine

ratios performed outside of pregnancy, during pregnancy there is a loss of the diurnal variation of protein excretion.21 The use of the 24 h test is fraught with Hormones antagonist difficulties resulting in inaccuracies.22

In pregnancy the physiological dilatation of the ureters and incomplete bladder emptying as a result of the enlarging uterus can cause significant collection errors.18 These errors can be avoided by ensuring adequate hydration and standardization of the collection technique (discarding urine at the beginning of the collection and lying in left lateral recumbency for 45 min at the end of the collection to remove any partial obstruction related to supine or upright posture).18 The renin-angiotensin-aldosterone system (RAAS) has been investigated in preeclampsia. The normal physiological response of the RAAS in pregnancy is an increase in circulating renin, angiotensinogen, angiotensin II and aldosterone.7,23 Pregnant women are Histone demethylase resistant to the pressor effects of angiotensin and despite these changes remain normotensive throughout pregnancy. In contrast, women with preeclampsia have normal or below normal levels of renin, aldosterone and angiotensin II.23–25 Despite these hormonal changes in women with preeclampsia, they paradoxically have a reduction in plasma volume.26 The decline in plasma volume occurs several weeks prior to the rise in blood pressure and the other clinical manifestations of preeclampsia. Despite the decline in plasma volume prior to the onset of disease, women who will develop preeclampsia do not salt waste but do demonstrate an exaggerated diuresis in response to sodium loading.

While classically considered an immunologically privileged site, we currently know that the CNS is a target of immunosurveillance, even though it contains particularities capable

of modulating the inflammatory process (17,18). Water-soluble substances can flow from the CSF to the brain parenchyma and vice-versa, and solutes entering the brain through the blood–brain barrier (BBB), as well as those synthesized by the brain, diffuse freely from the brain interstitial fluid into the CSF (8). Matrix metalloproteinases are usually https://www.selleckchem.com/products/pexidartinib-plx3397.html not detected, or exist in extremely low concentrations in the CNS under normal conditions, but they are found in higher concentrations in severe neuronal disorders and after injury (19). Furthermore, the MMPs detected in the CSF may have passed through the injured BBB or blood–CSF barrier. In a recent study focused on MMPs CHIR-99021 cost in the

serum of dogs with VL, high levels of MMP-2 and MMP-9 were detected (20). Interestingly, we found no correlation with the levels of MMPs in serum and in CSF (data not shown), which give evidences that the MMPs in the CSF were not originated from serum, but were generated within the nervous milieu. In fact, in another recent paper from our research group, it was noticed that in the brain of dogs with VL, MMP-2 varied according to the symptoms, and, in a similar manner that occurs in the CSF, elevated amounts of MMP-9 was observed see more in the infected groups, with no symptoms variation (21). Systemic infections

might result in changes in the selectivity of the BBB or blood–CSF barrier (22), and as a consequence, the CNS may become more susceptible to the entrance of inflammatory cells, pathogens and others substances that are circulating in blood. The neurological symptoms during L. chagasi infection are the result of chronic meningeal inflammation (23). Lima et al (24). detected high titres of anti-Leishmania antibodies in the serum and CSF of dogs with VL and proposed that changes in the permeability of the BBB and/or blood–CSF barrier would permit the entrance of antibodies, antigens and others proteins into the CNS. Matrix metalloproteinases, instead of have entered to the nervous environment by an injured brain barrier, may be, in fact, the causative of that injury (7), thereby permitting the passage of the antibodies and lymphocytes previously described (5,24). An important fact that could have influenced the MMPs detection was the different immunologic status of the dogs, because of different phases of infection. In an attempt to avoid this interference, it was provided a division of the infected dogs into three subgroups according to the symptomatic classification, but no differences in the MMPs levels were detected. It is an important result, as that the detection of MMPs varies with the infection by L. chagasi, and seems not to be influenced by symptoms.

, 1989) of treatment of intermittent infection with P. aeruginosa, which consists of a combination of inhaled colistin and oral ciprofloxacin used with

increasing dosage and for increased duration at reinfections (Hansen et al., 2008). However, inhaled tobramycin and oral ciprofloxacin, both of which target the metabolically active biofilm subpopulation, have been shown to have similar good results as inhaled colistin check details and oral ciprofloxacin in the early treatment of CF patients (Taccetti et al., 2012). This is probably due to the predominant effect of oral therapy on bacteria situated in the respiratory zone of the airways and of inhaled therapy on bacteria situated in the conducting zones of the respiratory tree. The synergistic effect of colistin and ciprofloxacin observed in in vitro biofilm studies might be tested only when quinolones become available for inhalation (Geller et al., 2011; Hoiby, 2011) and their combination therapy learn more can be investigated. Recently is has been shown in CF patients that combined colistin–tobramycin inhalation significantly decreased bacterial burden and that in animal and in vitro studies colistin–tobramycin combination was superior to monotherapy with regard to the killing of biofilm

P. aeruginosa (Herrmann et al., 2010). The rationale behind recommending combination therapy is, in addition to attacking various biofilm bacterial subpopulations, prevention of the development of antibiotic resistance especially when hypermutable isolates are selected (Macia et al., 2005, 2006). Biofilm susceptibility testing of 100 CF isolates demonstrated diminished activity of several antipseudomonal antibiotics compared with standard in vitro susceptibility testing,

and suggested that the use of standard drug dosages result in suboptimal drug concentrations at the site of infection (Moskowitz et al., 2004). Moriarty et al. (2007) measured sputum and serum concentrations of antibiotics in CF patients and showed that key PD parameters associated with clinical effectiveness for ceftazidime and tobramycin were not achieved at Reverse transcriptase the site of infection in the lung after intravenous administration. The negative effects of biofilm subinhibitory concentration are multiple: lack of bacterial killing, development of antibiotic resistance due to exposure of bacterial cells at concentrations lower than the mutant-preventing concentration, and enhancement of biofilm formation. It has been shown that sub-MIC concentrations of aminoglycosides (Bagge et al., 2004; Hoffman et al., 2005), beta-lactam antibiotics (Bagge et al., 2004) and quinolones (Takahashi et al., 1995) upregulate genes involved in biofilm formation. So high dosages are required to achieve effective treatment of biofilms based on in vivo PK/PD studies (Hengzhuang et al., 2012). In addition, the low oxygen concentrations present in the CF mucus (Worlitzsch et al., 2002; Kolpen et al.

Modifiable risk factors such as obesity, lifestyle, sleep position and medication usage should be addressed. Proteinuria has been described in SA.54–57 Urine dipsticks have shown greater degrees of proteinuria when performed at the time of polysomnography.54,55 Quantification of urine protein has also demonstrated greater proteinuria in SA patients compared with those without SA.56 Case reports have described

improvement or even resolution of proteinuria with treatment of SA.57 Not all studies have shown the association of proteinuria with SA however.58 The potential causes of proteinuria in SA are similar to factors associated with SA and CKD. Focal segmental glomerulosclerosis as discussed above is one plausible lesion that may occur with SA and result in proteinuria. The heightened sympathetic tone and intermittent intrarenal selleck products haemodynamic changes caused by apnoea and hypopnoea may potentially lead to damage within the nephron. Ischaemia and reperfusion injury can lead to oxidative stress and free radical formation as previously described.52,59 Lower circulating nitric oxide levels have been demonstrated in SA patients compared with the general population, further suggesting hypoperfusion and ischaemia.60 Elevated vascular endothelial growth

factor levels have been demonstrated in SA patients.61 Repetitive injury to the kidney as described above can lead to transient and even sustained damage within the kidney. In the obese patient SCH 900776 mw with isolated proteinuria, screening for SA may be warranted as part of the work-up. Isolated proteinuria is detrimental to renal function. Moreover, this subset of patients is at greater risk for complications of SA such as heart disease and cerebrovascular disease.

Aggressive treatment of SA with positive airway devices or lifestyle medication should be important in this population. The relationship between renal transplant and SA can be viewed as a paradox. As mentioned above, renal transplant can potentially improve SA in the dialysis population but the post-transplant state adds another dimension of risk for SA specifically by predisposing patients to the metabolic syndrome. Case reports have shown renal transplantation improves or cures SA in patients on dialysis.31,39,40 If the uremic milieu were responsible for SA, the cure Fossariinae of SA by renal transplantation seems plausible in a subset of patients who develops SA during dialysis. However, the few cases of cure after renal transplantation have not translated into an overall lower rate of SA in renal transplant patients compared with dialysis patients. The actual prevalence of SA in renal transplant patients may be comparable with the dialysis population. Although the Berlin Sleep Apnea Questionnaire has not been validated in CKD patients, Molner et al.62 used the Berlin Sleep Apnea Questionnaire to assess risk of SA in 1037 kidney transplant patients and 175 patients wait-listed for transplant.

Background: MK is a novel cytokine, which is pathologically

implicated in a number of inflammatory disease processes including kidney disease. It has potential as both a biomarker and a biological therapeutic target in acute and CKD. To date there is little data on MK levels in humans with CKD. Method: This is a prospective, observational study. Plasma, serum and urine samples were simultaneously obtained from CKD outpatients and healthy I-BET-762 volunteers (HV), stored at −70°C, and assayed for MK levels using a commercially available MK-ELISA kit (Cellmid Ltd, Sydney, Australia). MK levels were compared between 2 severity groups, divided as HV and stage 1–2, compared with a second group of stage 3–5. Result: Samples were obtained from 20 HV and 126 CKD patients. Serum MK levels were significantly higher in the CKD stage 3–5 group than the HV or CKD 1–2 group (3009 (SD = 1942) vs 870 pg/mL (SD = 384) P < 0.001). Urine MK levels were significantly higher in the CKD stage 3–5 group than the HV or CKD 1–2 group (6008 (SD = 13462) vs 654 pg/mL (SD = 1517) P ≤ 0.001). Conclusion: Serum and urine Midkine levels are elevated in stage 3–5 CKD patients compared to non-CKD or lesser stages 1–2. Whether this is association, or reflecting

part of the pathological process Afatinib order requires further exploration. 161 MIDKINE LEVELS CAN BE MEASURED IN EITHER PLASMA OR SERUM V CAMPBELL1,2,3, NA GRAY1,3, C ANSTEY2,3, R GATELY1, C CLARK1,2, E NOBLE1, K MAHADEVAN1,2, PR HOLLETT1,2, A POLLOCK1, D JONES4, S HALL5 1Renal Unit, Nambour General Hospital, Nambour, Queensland; 2Sunshine Coast Clinical School, The University of Queensland, Nambour, Queensland; 3Intensive Care Unit, Nambour General hospital, Nambour, Queensland, Australia; 4Cellmid Ltd; 5Pathology North – Hunter New England Aim: To compare Midkine tuclazepam (MK) levels when measured in plasma and serum. Background: Midkine is a novel cytokine, which is pathologically implicated in a number of inflammatory and malignant disease processes. Levels have usually been measured in serum, however protein assays can be performed on either plasma or serum. Because of the increasing number of both

serum and plasma banks being stored as part of large clinical trials, validating the assay in both sample types would allow further investigation of this cytokine. Methods: Plasma and serum samples were simultaneously obtained from chronic kidney disease (CKD) outpatients and healthy volunteers (HV), stored at −70°C, and assayed for MK levels using a commercially available MK-ELISA kit (Cellmid Ltd, Sydney, Australia). Data were analysed using multivariate linear regression. Results: Samples were obtained from 20 HV and 126 CKD patients. The causes of CKD included 26% diabetes, 37% hypertension/vascular, 9% glomerulonephritis, 5% polycystic disease, and 24% other. The CKD stages ranged from 1–5, with the majority being stage 3–4.

DC mobilization from peripheral tissues relies on pattern Selleck Dabrafenib recognition receptor signalling to promote DC maturation. Accordingly, MV acts as DC-SIGN and TLR2 agonist 7, 9 and induces phenotypic maturation (including upregulation of MHC and co-stimulatory molecules and cytokine release), morphodynamic changes and enhanced motility of infected DC on fibronectin (FN) supports 10. In contrast, CCR5/CCR7 switching, MHCII upregulation, and IL-12 production are less efficiently induced by MV as compared to other maturation stimuli 11, 12. These differences do, however, not explain the inability of MV-infected DC (MV-DC) to promote T-cell expansion in vitro 12–14. Rather, ligation of an

as yet unknown surface receptor by the MV glycoprotein (gp) complex (displayed on the surface of MV-DC) interferes with TCR-stimulated activation of the phosphatidylinositol-3(PI3)/Akt kinase pathway. This efficiently abrogates

activation of downstream effectors essential for actin cytoskeletal reorganization and cell cycle entry (reviewed in 15–17). MV contact induced activation of sphingomyelinases in T cells which accounts for its interference with cytoskeletal dynamics 18, yet molecules and mechanisms actively conferring IS instability to MV-DC/T-cell conjugates are poorly characterized. The mature IS segregates molecules involved in peptide recognition and TCR signalling from surrounding molecules also including those involved in stabilization and adhesion. It is an area of highly active cytoskeletal rearrangement, which essentially controls centripetal movement of TCR Torin 1 microclusters, but also receptor segregation including that of integrins, which regulate both TCR microcluster Carbohydrate confinement and stability of the DC/T-cell conjugate (for a recent review 19). Initially described as guidance factors regulating axonal path-finding during neuronal development, the general ability of semaphorins (SEMAs) to act as adhesion/repulsion cues

has meanwhile highlighted the importance of these molecules in diverse physiological functions also including vascular growth, cell migration, and immune cell regulation 20–23. SEMAs share a common “SEMA” domain and are divided into eight subclasses, and those expressed in vertebrates are membrane associated (class IV-VII) or secreted (class III, SEMA3 species). Class VIII summarizes virally encoded, secreted SEMAs with similarity to SEMA7A, and modulate immune activation by acting on monocytes 21, 24, 25. Most membrane-resident SEMAs use members of the plexin family for binding and signalling, while most SEMA3 molecules require neuropilins (NP-1 or -2) as obligate binding receptors for initiating cellular responses through plexins. In addition to using these receptors, certain SEMAs (SEMA7A and SEMA4A and 4D) also signal to their immune effector cells by interaction with integrins, CD72, or TIM-2 23, 26.

The hallmark cytokines secreted by the Th17 cells include IL-17A, IL-17F, IL-21 and IL-22.[62] This collection of cytokines can excite B lymphocytes, and trigger local

inflammation and tissue injury in SLE. The role of IL-17 in SLE pathogenesis has been explored in both human and animal models of lupus. In MRL/lpr mice, there was enhanced IL-17 mediated tissue insult after ischemic-reperfusion of the gut.[63] Diminished splenic germinal centre formation as well as suppressed anti-DNA and anti-histone antibodies levels were observed in IL-17R-deficient BXD2 mice.[64] Furthermore, splenocytes from SNF1 mice produced more IL-17 than non-autoimmune B6 mice.[65] Caspase activation CD3+CD4−CD8− T cells from MRL/lpr mice secreted abundant IL-17 and the expression of IL-17 and IL-23 receptors in the lymphocytes from these mice were upregulated as the disease progressed.[66] These

lymphoid cells from MRL/lpr mice, after treatment with IL-23 in vitro and transferred to non-autoimmune species, can induce nephritis.[66] Mice lacking IL-17 in FcγR2b-deficient lupus mouse model showed better survival and were largely protected from development of glomerulonephritis.[67] In lupus-prone C57BL/6-lpr/lpr mice, IL-23R deficiency was associated with reduced IL-17-producing cells in the lymph nodes, decreased anti-DNA antibodies and abrogation of lupus nephritis.[68] These findings denote that an aberrantly learn more active IL-23/IL-17 axis is responsible for the development of nephritis in lupus-prone mice. Increased circulating IL-17 and IL-23 levels were seen in patients with SLE and such elevation correlates with disease activity.[69] Recent data have suggested that a substantial amount of IL-17 in SLE patients is contributed by the TCR-αβ+CD4−CD8− T lymphocytes.[70] These TCR-αβ+CD4−CD8− T cells and Th17 cells are also detected in kidney biopsies

from SLE patients with renal involvement, hence provide strong evidence for the pathogenic role of IL-17 in lupus nephritis.[70] In addition, IL-17 assumes a crucial role for the survival and proliferation of B lymphocytes and antibody secretion in human SLE.[71] Yang et al. demonstrated the presence of Th17 cells in the PBMC and involved organs of SLE patients and the percentage increased Thymidylate synthase with disease activity.[72] Moreover, the IL-17 from SLE patients can induce adhesion molecule mRNA expression and the adhesion of T cells to endothelial cells.[72] To date, most of the available data of IL-17 and human lupus are derived from observational or correlation studies. Hence, there is limited experience in the manipulation of IL-17 for the treatment of SLE. Therapeutic approaches that limit the cognate interaction between T cells and B cells, prevent inappropriate tissue homing and restore TReg function and the normal cytokine milieu have been explored.

2B). These data indicate that Sin1 may not be required for peripheral T-cell differentiation. We have previously shown that suppression of FoxO1 and FoxO3a transcriptional activity by Akt is dependent on Sin1 and mTORC2

in MEFs and in B cells [[6, 13]]. FoxO1 is a positive regulator of L-selectin (CD62L), CD127 (IL-7 receptor alpha chain, IL-7R), and Foxp3 gene expression in T cells [[15, 16]]. Therefore, we asked if Sin1−/− T cells exhibit increased expression of these FoxO1-dependent genes. XL765 concentration CD62L expression was increased on the splenic CD4+CD44lowCD62L+ Sin1−/− T cells relative to Sin1+/+ T cells (Sin1+/+, MFI = 8520 versus Sin1−/− MFI = 17,400 (Fig. 2C) but CD127 expression was equivalent on Sin1+/+ and Sin1−/− peripheral T cells (Fig. 2D). The transcription factor Foxp3 is the master regulator of Treg-cell development. To assess the possible role of Sin1 in Treg-cell development, we first determined the proportion of thymic Treg cells in Sin1+/+ and Sin1−/− chimeric mice. We observed that Sin1−/− thymocytes gave rise to twofold more CD25+Foxp3+ Treg cells when compared with Sin1+/+ thymocytes (4% Sin1+/+ CD4+CD25+FoxP3+ GDC-0068 in vitro versus

10% Sin1−/− CD4+CD25+Foxp3+) (Fig. 2E), indicating that Sin1 may be a suppressor of thymic Treg-cell differentiation. The proportion of CD25+Foxp3+ T cells in the spleens of Sin1+/+ and Sin1−/− chimeric mice was not significantly different (9% Sin1+/+ CD4+CD25+Foxp3+ versus 10% Sin1−/− CD4+CD25+Foxp3+) (Fig. 2E). To determine if the Sin1-mediated suppression of L-NAME HCl thymic Treg-cell development is cell intrinsic, we generated Sin1−/− chimeric mice containing an equivalent ratio of Sin1−/− fetal liver cells (CD45.2+) and WT cells (CD45.1+). There were two times more Sin1−/− CD25+Foxp3+ Treg cells than WT Treg cells (7% Sin1+/+ CD4+CD25+Foxp3+ versus 15% Sin1−/− CD4+CD25+Foxp3+) in the same host (Fig. 2F). These data indicate that Sin1 inhibits the development of thymic Treg-cell development in a cell intrinsic manner. Akt is a negative

regulator of Treg-cell development [[17]] and Akt activity is directly regulated by mTORC2 [[6, 13]]. Since Sin1−/− cells lack mTORC2 function and exhibit deficiencies in Akt phosphorylation and function, we hypothesized that Akt may mediate mTORC2-dependent signals to suppress thymic Treg-cell development. To test this hypothesis, we measured the proportion of thymic Treg cells in Akt-deficient mice. We determined the proportion of CD4+Foxp3+ Treg cells in the thymus of WT, Akt1−/− or Akt2−/− mice. We found that Akt1−/− and Akt2−/− mice had an equivalent proportion of CD4+Foxp3+ T cells when compared with WT mice (Fig. 3A). In addition, we also analyzed thymic Treg-cell development in Akt1−/−Akt2−/− fetal liver cell chimeric mice (these mice die at late embryonic stage E18–19).

FlowJo software (Tree Star, Ashland, OR, USA) was used for analyses.

One percent false-positive events were accepted throughout the experiments. Mixed lymphocyte reaction (MLR).  Twenty thousand DC were cultured ABT-263 research buy with 2 × 105 allogeneic PBMC depleted for monocytes and stained with CFDA-SE (Invitrogen, Carlsbad, CA, USA). To improve the survival of the T cells, IL-2 (50 U/ml) and IL-7 (10 ng/ml; both from ImmunoTools) were added on the first day of coculture. On the fifth day of incubation, cells were harvested and analysed on a FACS Canto I flow cytometer. Cytokine measurements.  The level of secreted IL-12p70 was measured in the conditioned medium by a sandwich ELISA according to the manufacturer’s protocol (BioLegend, San Diego, CA, USA). Statistical analyses.  Statistical analyses were performed using GraphPad Prism, and the results were analysed using the Kruskal–Wallis test. Dunn’s post hoc test was used for comparisons of median values. The difference between groups was considered significant selleck chemical if P < 0.05. Five different concentrations of bromelain (100, 50, 25,

10 and 5 μg/ml) were tested to identify the bromelain concentration that would be the best stimulus. After 24 h of stimulation, cells were harvested and analysis of the cell size and viability revealed that cells stimulated with 25 μg/ml bromelain had the largest cell size and showed

the highest viability of the different concentrations tested, comparable with cells stimulated with the cytokine cocktail (cytokine DC) (data not shown). DC matured with 100 μg/ml bromelain showed very low viability; we therefore did not include this concentration RG7420 in vivo in further experiments. Phenotypic analyses showed a concentration-dependent upregulation of costimulatory molecules and maturation markers after stimulation with bromelain (Fig. 1). The generated cells were all CD14− (not shown), confirming that the generation of DC had been successful. CD80 was higher expressed on bromelain-stimulated cells than on cytokine DC. In addition to CD80/CD86 expression, the costimulatory molecule CD40 is required for the induction of powerful T cell activation [25]. Stimulation with bromelain resulted in higher median fluorescence intensity (MFI) for CD40 compared with cytokine DC (Fig. 1D). Expression of the migration marker CCR7 was not increased upon bromelain treatment, but CD38 surface expression was significantly upregulated when compared with cytokine DC (Fig. 1C). None of the groups secreted high amounts of IL-12p70; however, cells stimulated with 25 μg/ml bromelain secreted slightly elevated amounts of IL-12p70 compared with cytokine DC (median 14.3 to 0 pg/ml, n = 7, data not shown).